Glaucoma progression in patients receiving intravitreal anti‐VEGF treatment for neovascular age‐related macular degeneration

Abstract

The purpose of this study was to investigate how often glaucoma and neovascular age-related macular degeneration (nAMD) occur in the same patient and to evaluate whether glaucoma progression is faster in eyes treated with intravitreal anti-VEGF medications for nAMD. Methods: This single-centre retrospective real-world data (RWD) consists of medical records of 6314 glaucoma and 2166 nAMD patients treated in 2008-2017 in Tays Eye Centre, Finland. To study glaucoma progression, changes in visual fields (mean deviation [MD], dB/year), IOP (mmHg/year) and fundus photographs (progression, yes/no) were compared in glaucoma eyes with and without anti-VEGF treatment for nAMD and ≥1 year follow-up. Results: During the 10-year period, 147 patients with glaucoma received intravitreal anti-VEGF treatment for nAMD corresponding to 2% of glaucoma and 7% of nAMD patients. The mean change in MD was −0.70 dB/year (SD 1.8) vs. −0.27 dB/ year (SD 1.7) (p = 0.027) in glaucoma eyes with (n = 37) and without (n = 4304) anti-VEGF injections, respectively. In patients with bilateral glaucoma and unilateral nAMD treated with anti-VEGF injections (n = 20), MD declined at −0.62 dB/year (SD 1.9) vs 0.33 dB/year (SD 1.5) (p = 0.654), and glaucoma progression was detected in 14/20 vs 10/20 (p = 0.219) fundus photographs in eyes with anti-VEGF treatment compared with their untreated fellow eyes. Conclusion: nAMD and glaucoma were found co-existing in the same eye at rates that were similar to the age-corrected prevalence of the two diseases in the general population. Our results suggest that intravitreal anti-VEGF treatment for nAMD may accelerate glaucoma progression.

Normal-Tension Glaucoma and Potential Clinical Links to Alzheimer’s Disease

“…Further, repeated intravitreal injections of Avastin in those with AMD and DME have been shown to cause sustained increased IOP, which can increase the risk for glaucoma development or accelerate existing glaucoma [188]. Additional studies support the finding that repeated Anti-VEGF injections can lead to elevated IOP in cohorts of patients diagnosed with DME, neovascular AMD [189,190], and non-diabetic patients [191], thus indicating the complicated interplay between NTG and efficacy of anti-VEGF treatments. Furthermore, the risk for intravitreal anti-VEGF treatments extends outside of the eye and has been implicated in possible Parkinson's-like events, hypertension-induced brain hemorrhage, and dementia [192][193][194].…”